不同手术方案治疗腰椎间盘突出症 合并腰椎失稳临床对比研究

Clinical comparison of two kinds of operation schemes in treatment of lumbar disc herniation combined with lumbar instability

摘要:

目的 探讨常规开放和微创改良经孔椎体间融合术（TLIF）对腰椎间盘突出症合并腰椎失稳患者 围手术期临床指标、ODI 评分及椎间融合率的影响。方法 研究对象选取腰椎间盘突出症合并腰椎失稳患者 共100 例，以随机数字表法分为A 组（50 例）和B 组（50 例），分别采用常规开放和微创改良TLIF 术式治疗； 比较两组患者手术用时、术中出血量、术后引流量、首次下地活动时间以及手术前后VAS 评分、JOA 评分、 ODI 评分、椎间融合率等。结果 两组患者手术用时比较差异无统计学意义（P >0.05）；B 组患者术中出血 量、术后引流量及首次下地活动时间均优于A 组（P <0.05）；两组患者术后3、和12 个月VAS 评分低于术 前（P <0.05）；B 组患者术后3 个月VAS 评分低于A 组（P <0.05）；两组患者术后12 个月VAS 评分比较差 异无统计学意义（P >0.05）；两组患者术后3 和12 个月JOA 评分、ODI 评分均优于术前（P <0.05）；两组患 者术后3 和12 个月JOA 评分、ODI 评分比较差异无统计学意义（P >0.05）；同时两组患者椎间融合率比较 差异无统计学意义（P >0.05）。结论 常规开放和微创改良TLIF 术式治疗腰椎间盘突出症合并腰椎失稳具有 接近的临床疗效，但微创改良TLIF 术式应用在降低手术创伤程度、促进术后康复及减轻术后腰腿疼痛程度 方面更具优势。

Abstract:

Objective To investigate the influence of modified transforaminal lunbar interbody fusion (TLIF) by open surgery and minimally invasive spinal endoscopy on perioperative clinical indexes, ODI score and intervertebral fusion rate of the patients with lumbar disc herniation combined with lumbar instability. Methods One hundred patients with lumbar disc herniation combined with lumbar instability were chosen and randomly divided into two groups including group A (50 patients) with open modified TLIF and group B (50 patients) with modified TLIF by minimally invasive spinal endoscopy. The operation time, the intraoperative blood loss volume, the postoperative drainage volume, the postoperative ambulation time, the VAS score, JOA score and ODI score before and after operation, and the interbody fusion rate were compared between both groups. Results There was no significant difference in the operation time between the 2 groups (P > 0.05). The intraoperative blood loss volume, the postoperative drainage volume and the postoperative ambulation time of the group B were significant better than those of the group A (P < 0.05). The VAS scores of both groups in 3 and 12 m after operation were significantly lower than those before operation (P < 0.05). The VAS scores of the group B were significantly lower than those of the group A in 3 m after operation (P < 0.05). There was no significant difference in the VAS scores between the 2 groups in 12 m after operation (P > 0.05). The JOA scores and ODI scores of both groups in 3 and 12 m after operation were significantly better than those before operation (P < 0.05). There were no significant differences in the JOA scores or the ODI scores in 3 and 12 m after operation between the 2 groups (P > 0.05). There was no significant difference in the interbody fusion rate between the 2 groups (P > 0.05). Conclusions Conventional open modified TLIF and modified TLIF by minimally invasive spinal endoscopy possess the same clinical effect in treatment of lumbar disc herniation combined with lumbar instability; but modified TLIF by minimally invasive spinal endoscopy can efficiently reduce the degree of surgical trauma, promote postoperative recovery process and decrease the pain degree after operation.